Endoscopic surgery has revolutionized a number of surgical procedures in specific areas of the body. Endoscopic surgery is surgery that is performed by inserting surgical instruments into the body through relatively small incisions, with the surgeon observing his own actions on a video monitor. The video camera, lighting, and all instruments that enter the body are operated by the surgeon from outside the body. Endoscopic techniques offer many advantages: they can be performed as outpatient surgical procedures; they typically entail shorter patient recovery time and less pain; and, they are more economical because there is less of the patient's time lost from work. Even in endoscopic procedures, however, both pain and recovery time increase when more instruments have to be inserted and removed during the procedures. Hence, it is desirable to limit the total number of separate devices that have to be inserted and removed.
Body fluids are present in the operative field during endoscopic procedures, just as with any other type of surgery. These body fluids can inhibit the view of the camera and prevent the surgeon from seeing clearly what he is doing. The surgeon's view may also be obscured by other fluids which may be introduced into the operative field as part of the procedure, such as with irrigation or aqua-dissection. As a sponge cannot be used in endoscopic procedures, suction devices must be used. These suction devices are generally some type of elongated tube attached to a source of vacuum, and are most commonly inserted into the body through an incision separate from that required for other surgical instruments. It is also necessary to irrigate the operative field during endoscopic procedures. This is usually accomplished by inserting into the body through yet another incision another tube attached to a source of saline solution or other irrigation fluid. Subsequently, irrigation fluids which are used must be suctioned back out.
Aqua-dissection is another procedure that is sometimes used in endoscopic surgeries. In aqua-dissection, irrigation fluid under pressure is injected into the body to break up areas of scar tissue or adhesions. Instillation of fluids under pressure creates cleavage planes which the surgeon can then lyse by sharp dissection. This procedure compensates for the general inability to use blunt dissection during operative endoscopy. Aqua-dissection also results in large volumes of irrigation fluids being instilled into the body, which fluids must then be suctioned out of the body so that the surgeon can see.
It is also sometimes necessary to place additional lighting, fiberoptic cameras, lasers or other devices into the operative field, all of which must be inserted through additional incisions, which results in increased pain and recovery time for the patient.
A problem with the current endoscopic suction devices on the market is that most of them are open-ended tubes that can become inadvertently suctioned onto body structures such as bowels or fallopian tubes. This not only blocks the removal of fluid, but can also cause injury. Such inadvertent suctioning onto body structures also requires the stoppage of surgery while the vacuum source is shut off and the suction device is released from the structure to which it is attached. When suctioning large volumes of fluids, these suction devices often become clogged with blood clots and other debris, which further precipitates the need for stopping the surgery and removing such debris.
Another problem with many suction devices of the prior art is that they use trumpet valves which can be clogged easily with blood clots and other debris. Again, when blockages occur at such valves, surgery must be stopped while the problem is corrected. Presently, hospitals charge approximately $3,400.00 for the first two hours of surgery, and charge an additional approximate amount of $1,200.00 for each hour thereafter. Difficult endoscopic cases may last as long as between 4 and 6 hours. It is readily apparent that decreasing operating room time can result in tremendous health care cost savings.
It may be readily observed, that a significant disadvantage of endoscopic suction and irrigation devices of the prior art, is that such devices do not typically allow for the seal-tight insertion of additional instruments, other than the endoscopic suction and irrigation devices, into the same tube used for suction and irrigation. Such disadvantage commonly prevents the use of the additional inserted instruments simultaneously with the use of irrigation or vacuum.
Devices for providing suction or irrigation have been used in surgery for many years, as can be seen by the following examples of the prior art. U.S. Pat. No. 1,531,213 by Nimmer discloses a tubular syringe designed only for injecting fluids in one of two selectable directions out of a shielded tube: It should be noted, that the Nimmer device is capable neither of performing suctioning procedures, nor of allowing for the seal-tight insertion of other instruments through the tube portion of the device. U.S. Pat. No. 2,568,566 by Sokolik discloses a suction and irrigation device comprising a two-way elongated cylindrical syringe connectable to a triple ported cross-head fitting, which fitting connects the syringe simultaneously to both a fluid-feeding inlet tube and a fluid-withdrawing outlet tube. The outer surface of the syringe of Sokolik further comprises a plurality of longitudinally extending corrugations or ridges divided by a plurality of longitudinally extending fluid collection channels, in an alternating radial arrangement. Each of the ridges contains an internal fluid feeding conduit which is open at a top end where it is in communication with the cross-head fitting and closed at a bottom end. A large central fluid withdrawing conduit is axially formed in the syringe, and is surrounded by the fluid feeding conduits and fluid collection channels. The fluid withdrawing conduit is also open at a top end where it is also in communication with the cross-head fitting and includes a small withdrawing orifice at a bottom end for withdrawing fluid from the bottom of a body cavity. The fluid withdrawing conduit further has a cross sectional area which corresponds to the combined cross sectional areas of the fluid feeding conduits. A plurality of inlet orifices is further provided on the inner edges of each ridge for spraying flushing fluid from the fluid feeding conduit within the ridge and into the fluid collection channels located on either side of the ridge. A similar plurality of outlet orifices is provided in the apex of each fluid collection channel for communicating between the collection channel and the fluid withdrawing conduit. Although the Sokolik device does provide for the simultaneous suction and irrigation of fluids, and further provides a novel method of solving the problem of bodily organs adhering to suction orifices, it does not allow for the seal-tight insertion of other instruments through either the cross-head fitting or the syringe portion of the device while simultaneously using such instruments with suction or irrigation. Furthermore, the design of the Sokolik device makes its production cost prohibitive when compared to the simple and economical design of the present invention.
U.S. Pat. No. 3,308,825 by Cruse discloses a suction device designed to overcome the tendency of suction devices to adhere to soft tissues via the provision of an outer tube member adjoined to the open end of a suction tube and including a plurality of annular ribs defining an external groove which is in communication with the interior of the tube member through a plurality of tube side ports. As well as failing to provide irrigation means, the Cruse device includes disadvantages which are similar to those displayed by the device of Sokolik: it does not allow for the simultaneous seal-tight insertion and use of other instruments through the tube portion of the device, and its design makes its production cost prohibitive when compared to the simple and economical design of the present invention.
U.S. Pat. No. 4,451,257 by Atchley discloses a surgical aspirator or suction device having a single poppet valve connected to an elongated aspirator tube and an outer similarly elongated shield surrounding the aspirator tube, and having a plurality of perforations and a squared off distal end. Unfortunately, this device cannot be used for both suction and irrigation. Also, the shape of the aspirator tube and shield would be inappropriate for most endoscopic surgery procedures. Further more, additional instruments cannot be inserted through the aspirator tube of the Atchley device for simultaneous use with the aspirator tube.
U.S. Pat. No. 4,487,600 by Brownlie et al. discloses a suction device that has an adjustable flow rate and a plurality of longitudinally spaced radial apertures adjacent to its free end, through which fluids may be suctioned. U.S. Pat. No. 4,767,404 by Renton discloses another suction device with a plurality of perforations for preventing the inadvertent attachment of the device to soft tissue. Neither the device of Brownlie et al., nor that of Renton is designed for the simultaneous seal-tight insertion and use of other instruments through the tube portion of the device.
U.S. Pat. No. 5,186,714 by Boudreault et al. discloses a multifunctional surgical device comprising a pistol-grip shaped holder that can be attached to various elongated instruments. One such instrument is a combination suction/irrigation device, with includes a plurality of orifices at its distal end. The handle of this device can also be attached to a cannula which can be used for inserting other instruments such as lasers, fiberoptics, etc., into the surgical area. However, these additional instruments cannot be introduced through the suction/irrigation tube of the Boudreault et al. device or used simultaneously with the suction/irrigation tube. Hence, when the surgeon wishes to use these other instruments, he must remove the suction/irrigation tube from the patient, disassemble the device, then reassemble it replacing the suction/irrigation tube, and insert the reconfigured device into the body of the patient. Thus, when compared to the operative procedure available through use of the present invention, any operative procedure using the device of Boudreault et al. and involving the use of a plurality of other surgical instruments would increase significantly both the time required to perform such procedure and the amount of pain and recovery time experienced by the patient. Also, the use of a pistol shaped handle for holding the operative instruments, as disclosed by Boudreault et al., would tend to reduce significantly the tactile sensitivity afforded to the surgeon through the instrument. A still further disadvantage of the teaching of Boudreault et al. is that the suction/irrigation device of said teaching fails to include effective and economical means for preventing adhesion of body members to the suction orifices.
U.S. Pat. No. 5,205,816 by Dodson et al. discloses a laparascopic device for suction, irrigation and blunt dissection. Blunt dissection is the parting of tissue by pushing it apart, as opposed to cutting or aqua-dissection. Similar to other endoscopic suction and irrigation devices of the prior art, this device has no accommodation for reducing clogging or sticking when suctioning, and also fails to include accommodation for the insertion of other instruments through the body of the device.
U.S. Pat. No. 5,241,990 by Cook discloses another basic suction/irrigation device and valving system which includes disadvantages of the prior art which have been already enumerated concerning other devices. This system does not include an optional shield for preventing the adhesion of body members to the suction device, or any means of inserting additional instruments through the body of the device for simultaneous use with the suction or irrigation means of the device.
U.S. Pat. No. 5,242,387 by Loughlin discloses a suction/irrigation device that includes a suction shield. The shield is a second body that fits over two separate tubes used to provide irrigation and suction means. The shield has a hemispherical dome at one end with a plurality of small orifices communicating with the interior of the shield, for allowing suction and irrigation in the operative field without clogging or suctioning onto a vital organ. However, those skilled in the art will recognize that the Loughlin instrument as designed cannot be used in the operative field without the shield, and hence cannot be used for aqua-dissection as can the present invention. Furthermore, other instruments such as monopolar knives or fiberoptic devices have to be inserted into the operative field separately from the Loughlin device and thus cause an increased amount of pain and recovery time when compared with the results available through using the present invention.